Dark Fungus, Deadly Outcome: Cladophialophora bantiana Brain Abscess in a Posttransplant Case

Abstract Cladophialophora bantiana is a rare neurotropic dematiaceous fungus that can cause fatal brain abscesses, particularly in immunosuppressed hosts such as renal transplant recipients. Early recognition is critical due to high mortality and diagnostic difficulties. A 25-year-old male renal transplant recipient presented 1 month posttransplant with generalized tonic-clonic seizures and altered sensorium. MRI revealed a thick-walled right frontoparietal abscess measuring 5.9 × 5.1 × 4.2 cm with mass effect. He underwent craniotomy with complete excision of the abscess. Gram stain, potassium hydroxide mount, and culture confirmed C. bantiana. Histopathology showed necrotizing granulomas with septate pigmented hyphae and acute-angle branching mimicking Aspergillus. The patient was treated with liposomal amphotericin B and intravenous voriconazole, and later transitioned to oral voriconazole. Despite initial neurological improvement, he developed sepsis and multiorgan failure, succumbing 19 days after surgery. This case highlights diagnostic pitfalls, including imaging resembling bacterial or tubercular abscess and histology mimicking Aspergillus, as well as therapeutic challenges of C. bantiana CNS infections in immunosuppressed hosts. Early diagnosis, surgical excision, prompt initiation of effective antifungal therapy, and careful management of immunosuppression are essential to improve outcomes.